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51 Cards in this Set
- Front
- Back
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Which of the following is the best scheme to use for a patient with active disease, complex restorative need and uncertainty about the prognosis for both disease control and treatment:
a). University of Michigan (traditional block system) b). Wood: Treatment Planning -- a Pragmatic Approach c). Barsh: Dental Treatment Planning d). Public Health Approach |
b). Wood: Treatment Planning -- a Pragmatic Approach
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For each of the following clinical scenarios, specify whether the patient needs:
a). Control Phase only (at this time) b). Definitive Phase only c). Control Phase and a Definitive Phase Scenario: Active Periodontitis (Case Type II): 6 incipient, 5 recurrent and 6 primary carious lesions; missing #14 and #19; uncertainty regarding the patient’s finances and motivation. |
a). Control Phase only (at this time)
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For each of the following clinical scenarios, specify whether the patient needs:
a). Control Phase only (at this time) b). Definitive Phase only c). Control Phase and a Definitive Phase Scenario: 6 remaining teeth (#2, 15, 23-26) -- all are non-salvageable due to caries and periodontal disease; patient wants and needs maxillary and mandibular complete dentures. |
b). Definitive Phase only
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For each of the following clinical scenarios, specify whether the patient needs:
a). Control Phase only (at this time) b). Definitive Phase only c). Control Phase and a Definitive Phase Scenario: Patient is missing #1, 2, 3, 4, 14-16 and requests a maxillary removable partial denture; stable periodontal health (Case Type II); recurrent caries #13D; no other active disease present and the occlusion is stable. Patient is motivated and compliant. |
b). Definitive Phase only
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Where would you generate the (initial) treatment plan for each of these patients?
Scenario: Patient is missing #1, 2, 3, 4, 14-16 and requests a maxillary removable partial denture; stable periodontal health (Case Type II); recurrent caries #13D; no other active disease present and the occlusion is stable. Patient is motivated and compliant. a). DXT b). Prosthodontics c). Operative Dentistry d). Periodontics |
b). Prosthodontics
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Where would you generate the (initial) treatment plan for each of these patients?
Scenario: 6 remaining teeth (#2, 15, 23-26) -- all are non-salvageable due to caries and periodontal disease; patient wants and needs maxillary and mandibular complete dentures. a). DXT b). Prosthodontics c). Operative Dentistry d). Periodontics |
b). Prosthodontics
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Where would you generate the (initial) treatment plan for each of these patients?
Scenario: Active Periodontitis (Case Type II): 6 incipient, 5 recurrent and 6 primary carious lesions; missing #14 and #19; uncertainty regarding the patient’s finances and motivation. a). DXT b). Prosthodontics c). Operative Dentistry d). Periodontics |
a). DXT
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Which of the following is not a recommended guideline for sequencing on the plan of care:
a) Larger carious lesions before smaller lesions b) Quadrant dentistry c) Address the chief concern ASAP d) Sequence by tooth number (#1-32) e) Carious lesions before defective restorations |
8. Which of the following is not a recommended guideline for sequencing on the plan of care:
d) Sequence by tooth number (#1-32) |
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Control Phase treatment should always precede Definitive Phase treatment; indirect cast restorations should always be done in the Definitive Phase.
a) Both statements are true and linked b) Both statements are true but are not linked c) First statement is true, second is false d) First statement is false, second is true e) Both statements are false |
c) First statement is true, second is false
e) Both statements are false Both answers highlighted in key |
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An asymptomatic tooth with a gross carious lesion and a necrotic pulp should always be managed (restored or extracted) early in the treatment plan.
a) True b) False |
False
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11. What are the key similarities between the current 2007 Guidelines for the Prevention of Infective Endocarditis (American Heart Association), and the current guidelines (1997/2003) on Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements (American Dental Association and American Academy of Orthopedic Surgeons)?
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*1 point: both antibiotic regimens recommend the same antibiotic and dosage (Amoxicillin 2 Gm or Clindamycin 600m) (30 min to) 1 hour prior to dental Tx
[other similarities: both protocols developed to maximize disease prevention (elimination of any oral infection, emphasize the need for meticulous oral self care, use premed only when known to be effective) and minimize undesirable outcomes (resistant organisms/ super-infection), only premed for high risk patients, only premed for dental procedures where there is higher risk of bacteremia, previous Hx of the disease (IE or HTJI) places the patient at increased risk, if the patient has not premedicated and the clinical situation now warrants it – give premed stat and proceed with Tx, you have the ultimate authority/ responsibility to determine what is the best way to manage your patient] |
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12. What are the key differences between the current 2007 Guidelines for the Prevention of Infective Endocarditis (American Heart Association), and the current guidelines (1997/2003) on Antibiotic Prophylaxis for Dental Patients with Total Joint Replacements (American Dental Association and American Academy of Orthopedic Surgeons)?
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0 points awarded for this question—many of you did not seem to have this info firmly cemented, so please be sure you have reviewed and understand the 2 different sets of Guidelines. Both are available on the School website under Clinical Protocols.
[2 key issues: 1) the medical conditions for which premed is recommended are entirely different (for IE there are 4 specific cardiac issues which place the patient at “highest risk”, and for HTJI the patient needs premed for the first 2 years following surgery and (forever) thereafter if the patient has any of the specified co-morbidities (e.g. diabetes) or immune compromising conditions (e.g. Rheumatoid arthritis)); 2) the dental treatment which warrants premed in a susceptible individual is different for the 2 conditions (for IE it is any procedure that involves tissue manipulation, and for HTJI it is a very prescriptive “laundry list” of dental procedures for which premed is or is not recommended)] |
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13. What modifications in the planning and delivery of treatment would you consider for a patient with severe CHF (congestive heart failure)?
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*1 point: Stress Reduction Protocol (good rapport and communication to answer patient’s questions and allay anxiety; early AM appointments, consider nitrous oxide, effective anesthesia (limit epinephrine -- .036 mg; do not use epi cord) – Malamed’s Medical Emergencies in the Dental Office is a great resource)
[other issues to consider: if severe, will need MD consult RE: risk for endocarditis/ antibiotic premed? Nitroglycerine premed? Prognosis? Limitations to dental treatment?; if on anticoagulants, consider bleeding potential (INR?); if left sided failure (most common) expect pulmonary edema and difficulty breathing – avoid supine position; be prepared for medical emergency (MI) and terminate procedure if patient becomes fatigued; if severe, may need limit Tx to Acute Phase or Control Phase only.] [see also Dental Management of the Medically Compromised Patient] |
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14. What modifications in the planning and delivery of treatment would you consider for a patient who is on hemodialysis?
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*1point: need identify 3 or more of the following:
• MD consult: prognosis? Need for antibiotic premed and/ or post op antibiotics? Medical limitations to dental Tx? Bleeding potential? INR values? • Altered drug metabolism/ excretion – caution prescribing meds that would be effected • Potential for hypertension – monitor BP • Poor wound healing – careful technique; may need to defer elective surgical procedures • Decreased immune response – emphasize prevention; may need antibiotic premed and/ or post op • Coordinate appointments with dialysis schedule (same day if heparin reversal; or day after dialysis) • If severe advanced kidney disease, may need to treat in hospital setting • With poor prognosis extensive elective Tx contraindicated [See Dental Management of the Medically Compromised Patient for additional information] |
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15. What modification in the planning and delivery of treatment would you consider for a patient who has been taking 10 mg of prednisone daily for the last 2 months? [note: 10 mg prednisone = 40 mg cortisol]
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*1 point for: Must assume adrenal-cortical compromise (i.e.patient does not have normal “fight or flight” response and is at risk for life threatening crisis in the dental chair); therefore the following modifications are indicated:
• Assess the anticipated level of stress (patient anxiety?; any current infection?; doing surgical procedure?) and consult with MD as to if and when and by how much the steroid dose needs to be increased • Stress reduction protocol (must control pain and anxiety) • Be prepared for medical emergency (acute adrenal crisis) • Patient has decreased immune response – need manage infection aggressively; emphasize the need for good oral self care • Patient has poor wound healing – need careful technique; elective surgical procedures may be contraindicated, or if done, use caution and must have thorough informed consent • Monitor for hypertension; candidiasis [see Dental Management of the Medically Compromised Patient for additional information] |
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Which of the following are part of the framework for managing a patient’s dental caries:
- Tooth surface specific diagnosis of carious lesions - Assess caries risk - Basic Caries Control Protocol - Supplemental Caries Control Protocol - Re-evaluation/Reassessment a). One of the above b). Two of the above c). Three of the above d). Four of the above e). All of the above |
e). All of the above
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Which of the following is not a component of the CRA (Caries Risk Assessment) on the UNC SOD EPR:
a) Number of exposed root surfaces b) Cariogenic rating of diet c) Frequency of dental visits d) Medical issues impairing salivary flow or ability to clean teeth e) None of the above (all are components of the CRA) |
e) None of the above (all are components of the CRA)
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18. What are the benefits of doing Caries Activity Tests (Salivary analysis) for a patient at high risk for dental caries?
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*1 point for (3) of the key benefits:
• Diagnosis: helps discern underlying microbial or salivary causes of the caries infection • Baseline information: quantitatively establishes microbial/ salivary parameters at the outset of treatment • Tracking mechanism: quantitative measure of the effectiveness of caries control measures over time • Guide to treatment: may reveal specific problems (diminished salivary output) that will require specific management (salivary substitutes) • Educational tool: provides a quantitative measure for the patient to recognize success (or failure) of the treatment; and serve to motivate the patient to meet established goals • Treatment planning aid: serves as a benchmark for success and provides a threshold for when it is appropriate to proceed with definitive TX |
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During initial periodontal therapy, the primary objective is to control or eliminate etiologic factors. The following therapeutic regimens are appropriate during this phase of treatment EXCEPT:
a). Removal of overhangs b). Caries control c). Endodontic therapy d). Extractions e). Minor periodontal surgery |
e). Minor periodontal surgery
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T/F: For cast restorations, the post-initial therapy evaluation must be completed before the final impression is taken.
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True
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The PITE D0170 appointment compares initial and post-treatment periodontal findings and reassesses the restorative plan of care. However, for partially edentulous patients requiring removable partial dentures, final impressions can be taken during active periodontal treatment.
a). Both statements are true b). Both statements are false c). The first statement is true; the second statement is false d). The first statement is false; the second statement is true |
c). The first statement is true; the second statement is false
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T/F: Definitive occlusal adjustment can be performed at any time during the course of periodontal treatment.
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false
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Procedures performed during the active phase of therapy include all of the following, EXCEPT:
a). Non-surgical therapy b). Surgical therapy c). Emergency care d). None of the above (all the above are performed during the active phase of therapy) |
d). None of the above (all the above are performed during the active phase of therapy)
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An incipient lesion should more likely be restored if:
1) There is a “catch” with an explorer tine 2) There is a zone of discoloration below the lesion in question 3) Few restorations exist 4) The patient has poor oral hygiene a) (1) only b) (1) and (2) c) (1), (2) and (3) d) (1), (2) and (4) e) All of the above |
d) (1), (2) and (4)
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An existing restoration should more likely be replaced if:
1) Gingival embrasure space is inadequate 2) Amalgam ditching is <1/4 the thickness of the enamel 3) Similar gingival overhangs are predicted 4) There is evidence of amalgam bluing a) (1) only b) (1) and (2) c) (1), (2) and (3) d) (1) and (4) e) All of the above |
a) (1) only
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The extent of proximal caries is:
1) Reasonably represented by its radiographic appearance 2) Somewhat over-represented by its radiographic appearance 3) Somewhat under-represented by its radiographic appearance 4) Somewhat misrepresented by its radiographic appearance a) (1) and (2) b) (1) and (3) c) (3) and (4) d) (4) only e) None of the above |
b) (1) and (3)
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Cervical notching (abrasions or erosions) should more likely be restored if:
1) They are sensitive to the patient 2) They are deep axially 3) They are an esthetic problem 4) The patient has good oral hygiene a) (1) only b) (1) and (2) c) (1), (2) and (3) d) All the above e) None of the above |
c) (1), (2) and (3)
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Marginal ditching of amalgam:
1) Is normal 2) May be significant or insignificant 3) Often does not require re-treatment 4) Is usually associated with recurrent caries a) (1) only b) (1) and (2) c) (1), (2), and (3) d) (4) only e) All of the above |
c) (1), (2), and (3)
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Key points in evaluation of abutment teeth using dental radiography include:
a). The presence and absence of caries b). Condition of existing restoration c). Length and shape of roots d). Amount of bone adjacent to roots e). All of the above |
e). All of the above
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The main difference in preparation of a diagnosis for a bound edentulous space versus an unbound edentulous space is:
a). A periapical radiographic is not needed for a bound edentulous space b). A panoramic radiographic is not needed for an unbound edentulous space c). No study casts are required for a bound edentulous space d). No study casts are required for an unbound edentulous space e). Stabilized record bases are required for mounting of casts for unbound edentulous spaces |
e). Stabilized record bases are required for mounting of casts for unbound edentulous spaces
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For a proper diagnosis and treatment plan, the mounted study casts:
a). May show only the teeth in question without display of surrounding gingival tissues b). May remain unmounted for treatment of a bound edentulous space c). Can be hand articulated for most, if not all, clinical scenarios d). Must represent all teeth and alveolar soft tissues and be properly oriented to one another e). None of the above |
d). Must represent all teeth and alveolar soft tissues and be properly oriented to one another
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If an endodontically restored tooth is considered as an abutment for a fixed partial denture, it should:
a). Possess a good apical seal b). Have no sensitivity to pressure c). Possess an intact restoration or be restorable d). Have no unrestorable caries or fractures e). All of the above |
e). All of the above
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T/F: The only patient population treated in the D.D.S. clinics at the UNC School of Dentistry that is not on an automatic recall schedule is the completely edentulous patient.
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True
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T/F: The combination syndrome is most often observed when there is a maxillary complete denture opposed by mandibular anterior teeth that contact with every swallowing or masticatory motion.
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True
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T/F: Severe cases of the combination syndrome may require extensive surgical procedures (bone grafting) to recreate a normal maxillary anterior ridge for adequate support.
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True
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T/F: Primary changes that are often observed relative to the typical combination syndrome are:
- Anterior ridge resorption - Tuberosity down growth - Papillary hyperplasia - Extrusion of mandibular teeth |
True
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T/F: Important treatment objectives for the complete and partial edentulous patient may include:
- First gain complete soft tissue health - The removable partial denture must include numerous positive occlusal and or incisal supports (prepared rests, etc.). - Must have occlusal schemes that will eliminate excessive pressures in the maxillary anterior region - Be very critical of VDO vs. VDR - Avoid overextended bases (soft tissue support areas) |
True
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The following information is required before obtaining an endodontic consultation:
a). Periapical radiograph from last year that shows the periradicular structures b). Patient symptoms after anesthesia is obtained c). Objective testing results before treatment is initiated d). All of the above e). None of the above |
c). Objective testing results before treatment is initiated
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The Endodontic Pre-Consultation Worksheet and the Referral For Endodontic Treatment Card are to be completed:
a). Before paging the endodontist to provide an endodontic consultation b). Before the endodontist arrives to provide the endodontic consultation c). After the endodontist arrives to provide the endodontic consultation d). After the endodontist has provided the endodontic consultation e). Only if root canal treatment is to be provided |
b). Before the endodontist arrives to provide the endodontic consultation
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T/F: Indirect pulp capping is the treatment of choice for caries that has entered the pulp.
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False
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It is important to perform a diagnosis for each tooth to be treated; the pulpal and or periapical diagnosis for a tooth may change over time.
a). Statement 1 and 2 are true b). Statement 1 is true; statement 2 is false c). Statement 1 is false; statement 2 is true d). Statement 1 and 2 are false |
a). Statement 1 and 2 are true
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The following are classifications for pulpal pathosis, except:
a). Healthy Pulp b). Reversible Pulpitis c). Irreversible Pulpitis d). Hyperemia e). Necrotic Pulp |
d). Hyperemia
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A DXT patient with normal bone support, a severe overbite, and traumatic ulcers on the palate from impingement by the lower incisors -- would warrant:
a) An Orthodontic consultation b) A Prosthodontic consultation c) A Periodontal consultation d) A, B, and C simultaneously e) Referral to Graduate Prosthodontics |
a) An Orthodontic consultation
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T/F: All patients who express interest in orthodontic treatment should receive an Orthodontic Consultation at their intitial DXT visit.
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False (for patients who need extensive Disease Control treatment the Ortho consult should normally be deferred until the completion of the Control Phase)
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The Predoctoral Orthodontic Treatment Plan includes your assessment of:
- Patient’s chief complaint - Facial evaluation - TMD - Overbite/ Overjet - Cross bite - Special Observations (e.g. hygiene, ankylosis, bruxism) - Caries Risk a) 4 of the above b) 5 of the above c) 6 of the above d) All of the above |
c) 6 of the above (interestingly, Caries Risk is not on the Predoct Orthodontic Treatment Planning form – but as a conscientious practitioner, you should do it anyway)
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A multi-function removable orthodontic appliance which is designed to replace #8 and 9, preserve the space for a missing #14, and provisionally maintain the existing Vertical Dimension of Occlusion, would most likely be fabricated:
a). During the Control Phase b). Between the Control and Definitive Phases c). During the Definitive Phase d). In the Maintenance Phase |
a). During the Control Phase
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Which of the following are benefits of having a Maintenance Phase plan of care:
- Emphasize a message of oral health promotion and disease control/prevention - Reinforce patient education - Practice management benefits including improved confidence and efficiency by the entire dental team - Evidence of professional competence a). None of the above b). One of the above c). Two of the above d). Three of the above e). All of the above |
e). All of the above
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Which of the following is least likely to be part of a Maintenance Phase plan?
a). Oral self care instructions b). Initial Caries Activity Tests c). Evaluate the periapical health of a root canal treated tooth d). Application of fluoride varnish e). Assessment of the fit and function of removable prostheses |
b). Initial Caries Activity Tests
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In general, posterior bitewing radiographs should be no more than 24-36 months old for those patients whose dental needs were moderate; for patients whose treatment included extensive restoration care this interval should be 12-18 months.
a). Both statements are true b). First statement is true; second statement is false c). First statement is false; second statement is true d). Both statements are false |
a). Both statements are true (this is a direct quote from the PTA Protocol)
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A patient who has completed both a Control Phase Plan of Care and a Definitive Phase Plan of Care will typically need _______________.
a). One PTA at the end of the Control Phase b). One PTA at the end of the Definitive Phase c). A Control Phase PTA and a Definitive Phase PTA (2 PTA’s) d). One PTA upon the student provider’s graduation (a PTA upon the student’s graduation is needed only if a PTA has not yet been done for the patient) e). C and D (3 PTA’s) |
c). A Control Phase PTA and a Definitive Phase PTA (2 PTA’s)
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T/F: The Disposition in the template for a PTA on EPR is primarily intended to reflect on the patient’s attitude, compliance, and response to treatment while under your care in the School of Dentistry.
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False (this is true for the Disposition in a Progress Note, but as part of a PTA the main issue is what will happen the patient in the future – who will be the care provider and where will maintenance services be provided?)
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